Healthcare Provider Details

I. General information

NPI: 1689927733
Provider Name (Legal Business Name): AJAY GUPTA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 E 23RD AVE #1405
DENVER CO
80238-2741
US

IV. Provider business mailing address

7777 E 23RD AVE #1405
DENVER CO
80238-2741
US

V. Phone/Fax

Practice location:
  • Phone: 720-935-0583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number18548
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: